Participant Contact Information Form

Evaluating Locally-Developed HIV Prevention Interventions for African-American MSM in Los Angeles

OMB: 0920-0913

IC ID: 199771

Information Collection (IC) Details

View Information Collection (IC)

Participant Contact Information Form
 
No Modified
 
Voluntary
 
42 CFR 241

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Attachment 3e Participant Contact Information Form Change.docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

528 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 528 0 0 0 0 528
Annual IC Time Burden (Hours) 88 0 0 0 0 88
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 3i Participant Contact Log 082511 Att 3i Participant Contact Log 082511.docx 10/14/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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